SummaryAlthough acute non-haemolytic febrile or allergic reactions (ATRs) are a common complication of transfusion and often result in little or no morbidity, prompt recognition and management are essential. The serious hazards of transfusion haemovigilance organisation (SHOT) receives 30-40 reports of anaphylactic reactions each year. Other serious complications of transfusion, such as acute haemolysis, bacterial contamination, transfusion-related acute lung injury (TRALI) or transfusion-associated circulatory overload (TACO) may present with similar clinical features to ATR.This guideline describes the approach to a patient developing adverse symptoms and signs related to transfusion, including initial recognition, establishing a likely cause, treatment, investigations, planning future transfusion and reporting within the hospital and to haemovigilance organisations.Key recommendations are that adrenaline should be used as first line treatment of anaphylaxis, and that transfusions should only be carried out where patients can be directly observed and where staff are trained in manging complications of transfusion, particularly anaphylaxis. Management of ATRs is not dependent on classification but should be guided by symptoms and signs. Patients who have experienced an anaphylactic reaction should be discussed with an allergist or immunologist, in keeping with UK resuscitation council guidelines.
The main treatment for many patients with Myelodysplastic Syndromes (MDS) remains red cell transfusion to attenuate the symptoms of chronic anemia. Fatigue can reduce a patient's health related quality of life (HRQoL), but there is little understanding of the optimal use of transfusions to improve this. A systematic review was performed to identify and appraise publications reporting the use of HRQoL instruments in patients with MDS. A total of 17 separate studies were identified that used 14 HRQoL instruments, but only one MDS disease specific HRQoL instrument (QOL-E) was reported. Two well established HRQoL instruments were most often used in MDS research (variants of the Functional Assessment of Cancer Therapy (FACT) and the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30)). Several common problems were identified in the published literature including a lack of power calculations to detect clinically relevant changes, small sample sizes and significant attrition rates for completion of HRQoL assessments, all of which limit the strength of any conclusions. There is no consensus on the optimal transfusion regimen to improve HRQoL in transfusion-dependent MDS. Future research into HRQoL within MDS is a pressing requirement. Studies should focus on the domains that are of most clinical importance to the patient as well as traditional quantitative changes of hemoglobin concentration. Am. J. Hematol. 84:671-677, 2009. V
There is insufficient evidence to demonstrate whether bleeding is a significant clinical problem that affects patients' HRQoL or IPs in either patients with MDS or patients with hematologic malignancies. Rigorously designed studies to assess the scale of this problem in both of these groups of patients are required.
There is potential for inappropriate use of transfusion administration sets when used in combination with modern infusion pumps with consequences for patient safety. The aims of our study were to (i) establish if the design and testing of transfusion sets specified in International Standard ISO 1135-4 are adequate for their current applications, (ii) identify if infusion pumps currently supplied in the UK for blood component administration are suitable for this purpose and (iii) determine the additional control measures needed to be applied by manufacturers and users to ensure patient safety. Keyword literature search was carried out to review and correlate important transfusion parameters with resultant adverse effects. Units for occlusion pressure, flow rate and haemolysis were standardised for ease of comparison. A sample of transfusion set instructions for use was reviewed. Principal suppliers of infusion pumps to the UK market were surveyed to identify those sold for blood transfusion, their recommended operating parameters and compatible transfusion sets. Previous work showed clinically unacceptable haemolysis at pressures above 40 kPa. Modern infusion pumps operate under negative pressures of up to 210 kPa. ISO 1135-4 design and test requirements do not match this performance and in particular omit testing under negative pressure. Transfusion sets surveyed did not indicate flow or pressure restrictions or specify the blood components with which they had been validated. ISO 1135-4 requires updating and has been initiated. Meanwhile, recommendations are made for transfusion set manufacturers concerning pressure limitations and restrictions on blood component type and for users concerning purchase, configuration and validation of infusion pumps and disposables.
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